You’ve recently noticed that spot in the mirror and felt that breakout coming.
But did you know that blemish has been brewing for a while?
That’s why the first step toward clearer skin is to understand not all acne is the same.
You can’t treat pimples like you’d approach an inflamed pustule.
There are four stages a spot has to go through before it becomes fully-fledged acne.
So we have called in our clinical skin expert, Samantha.
Who is here to help you demystify your breakouts and put acne classifications into perspective?
The 4 Types of Acne
First, a quick recap: why the heck does acne occur in the first place?
Your skin contains countless pores (news flash)—but do you know what that means?
Pores are tiny openings on your skin’s surface that contain a hair follicle and a sebaceous oil gland.
When your skin is healthy, these pores release sebum that moisturises your skin.
The problem is if debris from bacteria, white blood cells, and dead skin cells become trapped inside the pore, this leads to inflammation.
This causes swelling, rupturing the pore wall and allowing bacteria to spread into the surrounding area, leading to breakouts—a vicious cycle.
Whilst oil at healthy levels keeps your skin supple, an overproduction can increase your chance of developing acne.
In fact, (1) scientific evidence has found that the average rate of sebum production is much higher in those with acne than those without.
Acne can start mild but quickly progress into more severe forms such as cystic acne—inflamed lesions with a greater chance of scarring and causing post-inflammatory hyperpigmentation (PIH).
This is why it is essential to get your breakouts under control as soon as you are aware of them.
We cover this in our article 10 skincare hacks to prevent acne; we look at the factors that can cause your breakouts, such as hormones, genetics, lifestyle, and environment.
To get your condition under control, it is important to understand the four different acne stages which we discuss below, but first, let’s look at how a pimple is formed on your skin.
How Breakouts are Formed
When pores become infected, your breakout changes; thankfully, not every pimple reaches the second, third or fourth stage.
When it does, there are several forms your pimples may take, which we have outlined below, from mild to severe.
It’s also important to know that acne can be broken down into two classifications: inflammatory and non-inflammatory.
When a pimple starts, microscopic amounts of dirt and debris get trapped in the pore, and micro-comedones are undetectable to the naked eye—these are essentially baby blemishes.
This buildup of sebum and dead cells forms a plug that blocks the pore preventing it from opening and leading to even more buildup.
Now at this point, your blemish will become a full-fledged comedone. Yikes!
The Four Stages of Acne Classifications
Your dermatologists will visually assess your skin to determine the type and severity of your acne.
In general, acne falls into one of these four stages:
Grade 1: Non-inflammatory acne; this consists of micro-comedones, comedones, and the occasional papule and pustule.
Grade 2: This is still non-inflammatory acne; comedones, papules, and a few pustules may be present on your skin, mainly confined to your face.
Grade 3: At this level, inflammatory acne occurs. This acne severity classification is usually associated with papules, pustules, nodules, and the occasional cyst. It also can progress to a more severe form that may be present on your back; grade 3 is also associated with sensitivity and inflammation.
Grade 4: This is a chronic form of inflammatory acne and, aside from your face, may be present on your arms, back, chest, neck, and upper thighs. It can do untold damage in the form of acne scars and dark spots (PIH) if you don’t get this condition under control early enough.
With this acne classifications grade, a lot is going on in your skin:
- post-inflammatory pigmentation
- large dome-shaped lesions
- painful pus-filled cysts that have difficulty healing
- blackheads and whiteheads on your T.Zone
- acne scars classifications and treatment are challenging to assess and treat.
There are a few more types of acne which are worth discussing:
Acne fulminans: This is a rare form of acne which comes on abruptly in the form of acute inflammation that can lead to ulceration, aching of the joints, and even fever, as this study discusses (2).
Gram-Negative Folliculitis: This is an inflammatory acne disorder caused by a bacterial infection due to complications from Acne Vulgaris or Rosacea. It can be treated by antibiotic treatment.
Timely intervention by a dermatologist is critical when treating this type of acne,
Acne grades are diagnosed in the presence or absence of inflammation, observing the number and type of dominant lesions and how widespread the acne is.
Your treatment plan should consider many factors, including the causes of acne and your age,
The Best Treatment Options
Most acne medications and treatments often target only one or two of the critical factors that cause acne, which either decreases or blocks sebum production.
Mild to moderate grades 1 and 2
There are proven natural treatments that can help to keep your breakouts under control, which we discuss in our article on how to get rid of acne with essential oils.
Some over-the-counter medications and creams are enough to treat and clear your skin at this grade.
There are common side effects of topical medications ranging from mild irritation to dry skin, so you must watch your skin and become your label detective.
For moderate to severe grades 3 and 4
Systemic medications can be much more helpful.
Retinoids are Vitamin A derivatives that your doctor or dermatologist may prescribe; they regulate the process of healthy cell turnover, unclog pores, destroy bacteria, and reduce inflammation in your skin.
This is backed up by research (3), which shows that retinoids can help decrease the number of comedones and inflammatory lesions by as much as 50% to 70%.
Antibiotics such as doxycycline and minocycline help to kill off bacteria; the downside is that they can make you more resistant to other strains of healthy bacteria.
If you are experiencing hormonal acne, you may be prescribed birth control pills with other medications, such as retinoids, to get your breakouts under control.
How to Heal Your Acne
Don’t squeeze, pop or pick your pimples: you could push the infection down deeper, making matters worse and causing permanent scarring.
We advise our clients to keep their blemishes covered with a spot treatment as a deterrent, like Resq anti-blemish skin shot with salicylic acid and manuka to protect and heal pimples and ease inflammation.
Even if you leave your breakout alone, there’s still a good chance you’ll experience post-inflammatory hyperpigmentation (PIH), those brown spots that can linger for what feels like forever after a breakout.
Glo dark spot corrector is a highly-concentrated formula that will pull your hyperpigmentation deep from within your skin to eradicate it,
To Conclude, the naked truth
Effectively controlling your acne means managing it at every stage—and preventing breakouts from the outset is crucial.
Understanding the different acne classifications is essential; once you know the correct grade, you can treat your skin more effectively.
If you are experiencing Grade 1,2 acne, treat your skin with a combination of natural ingredients.
For stage 3, you may require over-the-counter topical medications.
For those with a more severe form of acne, grade 4 or 5, your doctor or dermatologist will diagnose your condition and prescribe a course of retinoids or antibiotics to help clear your skin.
We would also recommend talking to your doctor about any possible side effects from your treatment and discussing any concerns you may have.
Changes in Epidermal Lipids and Sebum Secretion with Aging.
Pseudo-acne fulminans associated with oral isotretinoin.
Why We Should Consider Evidence-Based Treatment Options for Truncal Acne